Pulmonary Embolism as the Initial Presentation of Coronavirus Disease 2019 in Adolescents

Panjabi, Anurag L; Foster, Rachel; McCarthy, Amanda M; Shah, Satish; AL-Wahab, Haitham A.; Greenleaf, Christopher E.; Su, Erik

doi:10.1097/inf.0000000000003106

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…Treatment was reported in 97 patients ( Supplementary Table 1 ): 24 (25%) were started on unspecified anticoagulants, 30 children (31%) were started on low molecular weight heparin (LMWH), and 12 (12%) on unfractionated heparin (UFH), while in 13 (13%) unspecified heparin therapy was used. Apixaban was used in 2 patients ( 13 , 22 ). Twelve cases (12%) were treated with acetylsalicylic acid (ASA) associated with anticoagulation in 9 ( 23 , 24 ).…”

Section: Resultsmentioning

confidence: 99%

Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review

et al. 2022

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COVID-19 and multisystem inflammatory syndrome in children (MIS-C) have been associated with a higher incidence of hypercoagulability and thromboembolic events (TEs), even in children, leading to relevant morbidity, and mortality. However, our understanding of such complications in childhood is limited. To better understand the incidence, clinical manifestations, risk factors, and management of COVID-19 and MIS-C-related TEs in children, a review of the current literature and a brief update on pathophysiology are given. Sixty-two studies, describing 138 patients with TEs associated with COVID-19 or MIS-C, were included. The overall number of TEs was 157, as 16 patients developed multiple TEs: venous TEs represented the majority (54%), followed by arterial thrombosis (38%, mainly represented by arterial ischemic stroke-AIS), and intracardiac thrombosis (ICT) (8%). Within the venous TEs group, pulmonary embolism (PE) was the most frequent, followed by deep venous thrombosis, central venous sinus thrombosis, and splanchnic venous thrombosis. Notably, 10 patients had multiple types of venous TEs, and four had both venous and arterial thrombosis including a newborn. Most of them (79 cases,57%) had at least one predisposing condition, being obesity the most frequent (21%), especially in patients with PE, followed by malignancy (9%). In 35% of cases, no data about the outcome were available About one-third of cases recovered, 12% improved at discharge or follow-up, and 6% had persistent neurological sequelae. The mortality rate was 12%, with death due to comorbidities in most cases. Most fatalities occurred in patients with arterial thrombosis. Pediatricians should be aware of this life-threatening possibility facing children with SARS-CoV-2 infection or its multisystemic inflammatory complication, who abruptly develop neurological or respiratory impairment. A prompt intensive care is essential to avoid severe sequelae or even exitus.

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Section: Resultsmentioning

confidence: 99%

Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review

et al. 2022

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“…Anticoagulant therapy should last at least 3 months, with monthly check-ups depending on clinical status and right ventricular involvement 21 . In other cases reported 7-10,12-14,23-27 (Table 2), the most frequent treatments were unfractionated heparin, enoxaparin, and some oral anticoagulants such as apixaban 7,27 . In this case, rivaroxaban was chosen due to its oral administration, accessibility, and adequate adherence to treatment.…”

Section: Discussionmentioning

confidence: 97%

“…For economic reasons and due to the clinical improvement of the patient after therapy, it was not possible to perform the study of thrombophilias such as screening for protein C and S, antithrombin III, Leyden factor V mutation, or genetic disorders of hypercoagulability as in other reports 10,27 . Only the lupus anticoagulant was positive, possibly induced by the viral infectious process since it is considered a factor that contributes to thrombosis in patients with COVID-19 5 .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism in an adolescent with COVID-19 pneumonia

Nuñez-Paucar,

De Coll-Vela,

Peña-Coello

et al. 2023

BMHIM

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Background: Pulmonary embolism (PE) is a complication reported in the adult population with coronavirus disease 2019 ; however, its documentation in the pediatric population is limiteda. Case report: We report the case of a 15-yearold male with obesity and Down syndrome who was admitted for severe COVID-19 pneumonia. On day 7 of admission, he presented with chest pain, hemoptysis, respiratory distress, and marked elevation of D-dimer. Pulmonary CT angiography found an extensive thrombus in the right lower lobar artery. He received treatment with enoxaparin and rivaroxaban and had a favorable clinical outcome. In the tomographic control 1 month after treatment, thrombus was not evidenced and was successfully resolved. Conclusions: There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.

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“…A variety of neurological complications associated with pediatric acute COVID-19 has been described including encephalopathy, seizures, encephalitis, Guillain-Barre Syndrome, acute demyelinating syndromes, movement disorders and psychiatric disorders. 144 Acute COVID-19 in children can also be complicated by cardiovascular events including myocarditis, 145 , 146 pericarditis, 147 , 148 pulmonary embolic events, 149 arrhythmias, 150 and acute myocardial infarction. 151 So-called “COVID toes,” or pseudo-chilblains, caused by inflammation of small blood vessels with painful sores can also be seen in pediatric acute COVID-19.…”

Section: Introductionmentioning

confidence: 99%